Why Healthcare.gov Sucks? Because They Hired Political Cronies, Not Internet Native Companies To Build It

from the you're-doing-it-wrong dept

There's been plenty of talk lately about just how screwed up the launch of Healthcare.gov has been. While any massively large-scale internet launch is likely to suffer some problems, the level of disaster on this particular project has been quite impressive. This has led some to wonder why this happened, especially given the reputation of President Obama's "web-savvy" campaign team. The answers aren't too hard to figure out, of course. First off, the campaign team is quite different from the team implementing this -- which was handled by the Department of Health and Human Services. But, more importantly: it appears that the federal government basically handed this project over to the same crew of giant government contractors, who have a long history of screwed up giant IT projects, and almost no sense of the "internet native" world.

The Sunlight Foundation (link above) figured out the list of contractors who worked on the site, and noted that the big ones not only are well-known DC power-player insiders, but they're also big on the lobbying and political contributions side of things. You've got companies like... Booz Allen Hamilton, famous for promoting cyberwar hype and employing Ed Snowden. There's defense contracting giant Northrup Grumman. Then there's SAIC -- which I can't believe can still get government business. This is the same firm that famously was given a $380 million contract to revamp the FBI system, on which it went $220 million over budget, and then saw the entire system scrapped after it (literally) brought some users to tears, and the FBI realized it was useless in fighting terrorism. SAIC is also the company that NYC Mayor Bloomberg demanded return $600 million after a city computer project (budgeted at $68 million) actually cost $740 million. SAIC has a long list of similar spectacular failures on government IT projects.

As you look down the list put together by the Sunlight Foundation, it's all companies like this: giant monstrosities which are simply tied in closely with the government. All the large consulting firms are listed: Accenture, Deloitte, PricewaterhouseCoopers, McKinsey. What's missing? Basically any company with even the slightest smidgen of experience building and maintaining large-scale, public-facing web-based apps. The list has no "internet native" companies.

Many, many years ago, I worked for an e-commerce startup here in Silicon Valley, and I ended up (sort of by default) in charge of trying to open up the government market for what we were doing. It involved meeting with a slew of all-too-slick, ex-politician, ex-military "consultants" with no technical knowledge whatsoever, who, for $15k to $25k/month retainers plus a (large) cut of any deal, would drink hard liquor and promise to "connect" us with big companies with government connections, and then help us sneak past the government bidding process to get no-bid contracts. It was an eye-opening experience that highlighted for me that getting government contracts in the tech world was very much about who you knew, rather than any actual knowledge, skills or experience. While this was quite a long time ago, it would appear that little has changed.

Government Contracts...

I once worked at a federal facility in NJ. While I was there the roof of the building caught fire. Some propane tanks exploded. There were/are some spectacular videos of it on YouTube (they may be been removed since). There had been some work being done on the roof and apparently basic safety protocols were not followed.

The contract to fix the now burnt/exploded roof went to the company who blew it up in the first place.

Regulatory Capture

What part of this is outright cronyism vs. regulatory capture? I know plenty of people who could build healthcare.gov quickly, reliably, and cheaply, but I've also seen plenty of government contracts. Those things can be monstrous, and there are plenty of qualified individuals unable to work on healthcare.gov solely because they couldn't (or wouldn't) want to comply with all of the government's rules. Imagine if you had to do a cost-benefit analysis or choose the lowest bidder on every sub-component of your system. Ugh.

Re: Government Contracts...

By "basic safety protocols weren't followed" he means oil-soaked rags were piled up and placed under a tarp on top of an asphalt roof on a cloudless, 90-degree day. Next to propane tanks.

Then the company tasked with the cleanup (as he said, same one that blew it up), hired laborers without any background check to come into a "secured" federal facility and haul the computers to storage. Cabinets were broken into, purses stolen, anything remotely valuable on desks vanished. This happened the weekend after the explosion, before employees were let back in to leave their personal effects. Then, they brought in another group to move out the furniture/filing cabinets/etc. and bring them to temporary storage. Those cabinets were all broken into while in storage. Unsurprisingly, this was followed by a sudden rash of identity theft.

THEN, after all that, they were awarded the contract to repair the roof.

Nebuchadnezzar's dream

not that i am that religious, but in the bible there is the story of the king with a dream about a composite statue; gold head, clay feet. aren't you afraid that you are looking at the clay feet right now? no trolling intended, but the US don't look very healthy to me.

PS: yes, in Holland we also screw up government IT, but not this way. it's just incompetence mixed with decadence over here.

I did support for a government agency that bought my companies products. The employees at said agency were quite competent. Unfortunately for them, it was contractors that ran IT. The contractors were excellent at having security clearance and that was about it.

BUT MIKE (relativity Mike..... relativity)

Compared to.... ??????

You should really watch this.

Applying for Health Insurance: Then and Now John Green attempts to apply for new health insurance coverage using the Affordable Care Act's insurance exchanges and then through a private insurer that existed before the ACA (aka Obamacare) went into effect.

So yeah the contractors are shitty relative to....But the process is far better relative to....

Your omission of the relativity to the "old" way of getting insurance "seems" to lack overall perspective. It still wouldn't mean that the contractors don't suck... as you clearly pointed out, they do suck.

Re: It's all perspective

Who is worse the corruptor or the corrupted. Private industry has created a system of government tender, via lobbyists to ensure services are privatised and targeted for highly profitable corruption.You will find government agencies hands are tied and they are required to function according to policy crafted by private corporations for the benefit of those private corporations.

I can tell you about SAIC

One reason SAIC gets the big government contracts is because they have gobs of people on hand with security clearances and "government experience". They employ lots of ex-military, ex-law enforcement dead weight, people who deliberately or perhaps from sheer ignorance always create the only kind of workplace they know how to function (barely) in: massive, entrenched, indispensible-by-design bureaucracies that burn through cash with no accountability whatsoever.

The FBI's case-file computer system modernization project was on the ropes when they finally called in subcontractors with real-world experience, and by then it was too little too late; the cronyism and culture of paranoia had for too long produced a hyper-siloed workforce that not only had no idea what some of the most basic practices were in software development or what actual real-world code looks like, but also had entire "teams" of unfire-able nincompoops who couldn't talk to each other (for fear of disclosing classified info) all working in adjacent rooms on nearly identical tasks that somehow only served to sustain the work of some mystery person down the hall, and precious little of any of this busy-work actually advanced the goals of the overengineered project.

The scope of the NYC timesheet computerization project grew like a cancer, but they at least had some first-rate development talent pulled in from far & wide (through subcontractors, mainly) from the get-go, and they did produce a real product that actually worked well enough to use and which could be supported by a small team of locals. However there was fierce opposition to the entire project from certain city labor groups the mayor was beholden to, groups who don't like the idea of computerized timesheets for some reason, so it eventually only rolled out to a fraction of the workforce. Oh, and there was apparently a huge amount of money being siphoned off in some cockamamie embezzlement scheme by some of the higher-ups whose actual jobs only consisted of touring the office every two months and encouraging everyone to keep up the good work.

So my impression of government IT contractors jives with Mike's... Even when SAIC has good people in the trenches, their projects always get sabotaged by incompetence, waste, and nepotism among the buffoons running the show. If anyone reading this has the opportunity to work for them, either run as fast as you can in the opposite direction, or be completely mercenary about it and bail at the first sign of trouble, before you get subpoenaed.

JavaScript, the Americans With Disabilities Act, and the Third Amendment.

One of Healthcare.gov's minor shortcomings is that, at last notice, it is JavaScript-dependent. To quote from the website:

"The page could not be loaded. The Healthcare.gov website currently does not fully support browsers with 'JavaScript' disabled. Please note that if you choose to continue without enabling 'JavaScript' certain functionality on this website may not be available."

They are saying, in effect, that they will not sell you insurance you are legally required to buy unless you let them run JavaScript programs on your computer. Granted, this is probably a case of Incompetence rather than Malice, but it still needs to be firmly stamped out.

Insistence on JavaScript, Flash, etc. for websites which perform essential government functions may not technically be a violation of the Americans With Disabilities Act, but only technically. It is certainly a violation of the spirit. With a standard interface- such as "clean" HTML, assistive technologies can hook up to known connection points. JavaScript breaks these known connection points. Certainly, I don't think a sensible bureaucrat would want to go to court over the matter, when he could just as well fix the website.

It is sometimes claimed that websites need JavaScript for input validation. However, input validation in client-side scripts (Java/JavaScript/Flash/etc.) is a dumb idea. A "bot" can easily intercept such scripts, and impersonate them. Input validation should always be done on the server side. Client-side validation validates nothing.

Likewise, it is unnecessary to use scripts for basic site navigation, for getting from the main page to various subsidiary pages. This also relates to the Americans With Disabilities Act. Subsidiary pages should be described in words, encoded as letters, and more specifically, as ASCII codes, and the standard link tag allows one to associate a string of text with a URL. An assistive device can easily identify a link, and skip from link to link.

Beyond that, use of JavaScript is stupid. JavaScript is well known as the primary facilitator of computer viruses, botnets, etc., and trying to legally compel people to use it comes very close to intentional sabotage. I habitually boycott commercial businesses which attempt to insist on JavaScript.Client-side scripting is a form of "unsafe sex," dangerous to both parties. It facilitates attacks in which the bugs of client and server are cascaded off against each other; the creation of self-propagating bot-nets which flow back and forth between servers and clients.

Certain video-oriented applications use client-side scripting as a matter of necessity or expediency, to expand video or game-state data from its compactest form into video. However, this kind of thing cannot be considered necessary for selling insurance.

-------------------------------

Indeed, compulsory Javascript may even be unconstitutional. In an article published twenty years ago Michael Swaine, of Dr. Dobb's Journal, pointed out that compulsorily installed software, such as JavaScript in this case, is a violation of the Third Amendment, which forbids quartering of soldiers in private houses.

At the time, there was a minor uproar about a legal case known as Engblom vs. Carey. Ms. Engblom was a New York prison guard who lived in a state dormitory on the prison grounds, for which she paid rent, and had a lease, just like a college student. There was a prison guards strike, and she was immediately locked out of her dorm room. The dormitory was subsequently used to house National Guard troops who were being used as strikebreakers. When Ms. Engblom was eventually able to return to her room, she found that her belongings had been looted by the National Guard. Available accounts are not clear, but presumably the Guard made off with television sets, stereos, sporting goods, etc., the kinds of things which could be readily sold at the local pawnbrokers, and the state government probably told them, unofficially, that such items were legitimate plunder. Ms. Engblom eventually sued the state (more specifically, the governor, Hugh Carey), and, in a novel move, her lawyer added a third-amendment claim. This probably reflected the difficulties of pinning down responsibility for the looting. The Federal Court of Appeals decided that Engblom had a legitimate case, but let the state off the hook on a technicality.

Swaine worked up an argument about how this might apply to computers, specifically to compulsory anti-virus software. He pointed out that a "soldier" can be a man, but it can also be a war-robot, or even a computer program, and a "house" can be a computer. One cannot really eliminate the possibility that General Alexander, of the NSA, is trying to get _his_ code into Healthcare.gov. The idea would be to carry out JavaScript-bug-based attacks on every single computer in the country, install massive number of botnets, and spy on everyone's private papers.

About the same time that Swaine was writing, the lawyer Tom W. Bell did a law review article on the Third Amendment, in response to Engblom vs. Carey. He found that cases of quartering had happened during the Civil War, but that there had been no legal remedy, and hence no case law. Other than that, there were simply no precedents.

Of course, commenting on Bell, one might observe that there is a historical discussion of the Army's role in settlement, notably Richard C. Wade, _The Urban Frontier: The Rise of Western Cities_, 1790-1830 (1959), and Francis Paul Prucha, _Broadaxe and Bayonet: The Role of the United States Army in the Development of the Northwest, 1815-1860_ (1953). The gist of these is that the Army was way out in front of settlement during the nineteenth century, building roads, sawmills and other infrastructure, and founding cities, which started as forts. Far from the Army wanting to lodge with the civilians, it was the civilians wanting to lodge with the Army. This was a major reason why the Third Amendment was moot in peacetime. It's much the same reason that there are almost no early American cases of "enclosure" (ie. Kelo-type takings). The economy was running in precisely the opposite direction.

There were a couple of exceptional cases where the Army bought forts from the fur-trading companies (Ft. Laramie and Ft. Bridger, I believe). These fur-trading forts had been founded by permission of the local Indian tribe, and subject to the axiomatic condition that white farmers were not welcome in the vicinity. I understand that when the Army tried to acquire the first Bent's Fort, along the Arkansas River in Colorado, the owner, William Bent, burned it down and told them to make their own improvements. He then moved downriver to where his trading partners (**), the Cheyenne Nation were now living, and built a new fort.

(**) And relatives, Bent having married into the tribe.

Something similar was happing in eastern coastal cities. The Coast Artillery was changing from flat-trajectory muzzle-loaders, with an effective range of three miles or less, to breech-loading, high trajectory guns (battleship-type) with a range of ten miles or more. It was abandoning in-bay forts, and moving to forts on the most remote available barrier-islands, where these guns could be used effectively. In San Francisco, the Island of Alcatraz became a prison because it was surplus in its original role, a Coast Artillery fort. One can observe that the significant Coast Artillery forts of the Civil War, places like Ft. Sumter, are, to this day, separated from their cities by belts of water and swamp. They were far enough out that the Confederates had to fight battles to occupy them, rather than merely making uneventful arrests.

I don't know about some other eastern cities, but at least for Boston, the dominant tendency was to put new real-estate developments on landfills in swamps, simultaneously abating a nuisance of mosquito breeding grounds while creating favorably situated land. A classic example is the Back Bay, the defining example of posh uptown districts. The building developers did not try to redevelop the inner city, a la Baron Haussmann in Paris. Hence there were no Kelo-type cases. That was left to the late twentieth century.

As for the Third Amendment in the Civil War, one must not view it in isolation, and lose sight of the whole atmosphere of dictatorship which the war brought in. Abraham Lincoln treated the Constitution as more or less completely optional, to be dispensed with when it got in his way. This was perhaps inevitable, given that the Chief Justice, Roger B. Taney, was a secessionist Marylander. Justice John A. Campbell, from Alabama, resigned in 1861, and entered the service of the Confederate government. In 1862-64, the Supreme Court got five new justices. This, of course, amounted to "Court Packing," of the type which Franklin Delano Roosevelt threatened, but did not actually carry out, during the Great Depression. Other incidents included the arrest and deportation of Congressman Clement Vallandigham of Ohio. Back in 1993, when I was in the History Department at Temple, one of my classmates in Professor Russell Weigley's American Military History seminar did a paper on soldier voting in the Civil War. One of his findings, as I recall, was that soldiers were brought in to vote in doubtful districts in states like Maryland, Kentucky, and Missouri, swamping the local inhabitants. The breaches of the Third Amendment, such as they were, occurred in a context in which the whole political process was being subverted. That is why presidents in difficulties, such as President Nixon in 1973, try to "wrap themselves in Lincoln," by way of saying that everything is permitted to them.

In many respects, the most outrageous single action of the Civil War was the execution of Mrs. Surratt, after trial by a military commission. Received historical opinion is that she was hanged as a kind of proxy for her son, who had made good his escape. The normal custom of the time and after was that ladies, however much they might have involved themselves in political conspiracies, were not to be executed. Cases which come to mind are the American Civil War spies Rose Greenhow and Belle Boyd; the French Commune leaders Hortense David and Louise Michel; and the Irish Rebel leader Constance Gore-Booth (Countess Markiewicz) in the aftermath of the Irish Easter 1916 Rising. About the only thing which could get a woman of some standing (*) hanged, was killing her husband (petit treason), or just possibly, her husband's children from a previous marriage. See Ann Jones's discussion in _Women Who Kill_ (1980), particularly the case of Mary Hartung, a boarding-house-keeper's wife who gave her husband rat poison because he was a rat. To put it in our terms, you do not _ever_ execute a twelve-year-old girl who has revenged herself on her molester, even if she has reduced him to hamburger with a twelve-gauge shotgun and a couple of boxes of shells. When you cross that line, you are into totalitarianism.

In short, this was the extremely messy context in which the comparatively minor offense of quartering troops took place.

(*) the type who employed servants instead of working as a servant. Before mechanization and modern plumbing, the most basic and profound social distinction was who cleaned up whose filth, eg emptying and scrubbing chamberpots.

Re: Nebuchadnezzar's dream

I suspect you would be hard-pressed to find someone from the US who doesn't agree with you. Well, ok, it seems to be easy to find those kind of crazies around, but they certainly aren't the majority. No trolling taken, that's a really apt comparison.

Re: BUT MIKE (relativity Mike..... relativity)

+1 on this. I'm a fan of John Green. It took him a little under an hour to apply for coverage under the ACA, even with multiple server failures. He only had to answer a few questions. On the other side, took him over 2 hours to apply on a site that was available both before and after ACA, he had to answer pretty much every health question imaginable and describe every visit or discussion with a doctor for the past 10 years.

So yes, the website has issues. Yes, it should've been done by a company that had more experience on the web. It is far from perfect. But despite all that, it is still better than what was there before (just like the law itself). Which for a government as disfunctional as ours, is almost amazing.

Re: BUT MIKE (relativity Mike..... relativity)

Healthcare.gov is not enrolling large numbers of people into plans. The old system was not great but one could buy insurance much faster than with Obamacare. I have trying to find what plans are available for me and their cost since Oct 1 with absolutely no success from Healthcare.gov. If I had been dealing with an insurance agent or company before Obamacare I would have some preliminary, non-binding quotes and policy information within a few minutes (e.g. company x will cost about y per month and will/will not cover this).

For a comparison, look at auto insurance. True one has to comparison shop various places to get competitive quotes. When one wants to buy, the companies try to make a user friendly as possible. Their ability to get new customers and renewals is dependent on customers being able to efficiently supply the information and get an accurate price. Even the comparison shopping is relatively easy even if the rates are not binding.

My Technical Assessment

It looks like the people who created this site had never created a commercial database web application before. Without a management change, one can't expect better results. The procurement process is the root cause of the problems. This is simply automating the process of filling out a paper form.

Re: JavaScript, the Americans With Disabilities Act, and the Third Amendment.

You have some fantastic arguments presented here. And I agree with the thought process behind it but quoting things said 20 years ago about mandatory software installs is ludacrous. There is absolutely no problems at all with well formed well written javascript and it is tin foil hats like yourself holding the world back in this area. You may as well take it one step further and argue that you have to use a web browser to view these pages as well. And if you want to get all up about this and say you are using things like wget guess what buddy they are also software you had to use to achieve your goal. Actually lets go one step further you have to use operating system software to get to this point. Seriously guys.... get off your old ass ideas and realise the world is a better place with new technology.

Unused resources

I work for one of the "usual suspects" contractors mentioned in the article. Specifically, for the insurance software division. Our group has years of experience successfully building enterprise-scale insurance web sites, both internal and public-facing.

This article was actually the first I heard that my company was involved with this project. Apparently, whatever group was involved with Healthcare.gov either didn't or couldn't consult the people in their own company who might've been able to help.

SAIC

I used to work for a company that got acquired by SAIC. Believe me, SAIC is a complete shambles. They excel at landing contracts but they deliver anything of value. A number of their senior management all belong to the same 'church' (I use that word loosely) of pseudo-Christian cultist types. There is corruption to the highest levels and a culture of spin within the company. I got out, fast.

SAIC

Sorry, type. I said 'anything of value'. I meant "nothing of value".

SAIC are involved in Guantanamo bay, they have projects involving training dolphins to deliver mines. The internal paperwork to get travel permits, you wouldn't believe. As a non-USA employee I had to fill out paperwork that specified explicitly that I did not need to carry concealed weapons and did not require body armour. "SAIC, not even once", is my advice.

lame

Accenture should have been handed the full contract

Remember how California's health exchange beat all the others on enrollment, and had some of the most positive feedback from consumers?

Accenture built that. I have no insight into my company's involvement in the federal exchange or their challenges, but I can guarantee you if we were chosen for the overall job the result would be much like what with did with California's exchange.

As a company we have a wealth of "internet native" experience, deep roots in Silicon valley and solid involvement with emerging technologies.

There was two root problems with the federal exchange: 1) They were not willing to pay what it would actually cost to build the monstrous site they promised, so had to cut corners, and 2) They divided up component development, without giving any thought to the eventual integration and without putting any one company in charge of the overall result.

Who else thinks the government should have hired whoever does those popular porn sites to do their healthcare site? Those things never crash and probably have more hits than healthcare website will ever get. Healthtube? YouHealthCare?

Re: Govt is Non-Essentials over Essential

Come out and get some fresh air. NPR does not receive any direct federal funding. The federal money it does receive (a grand total of $3.6 million, about 2% of NPR's total revenue) is from a small number of competitive grants from the Corporation for Public Broadcasting and federal agencies like the Department of Education and the Department of Commerce. NPR hasn't had any significant dependance on the federal government since the 1980s.

In contrast, the Department of Defense's 2011 budget was $680 billion dollars. $283.3b for operations and maintenance, $154.2b in wages, $140.1b in general buying, $79.1b in R&D, $23.9b in construction, and $3.1b in housing.

Re: Regulatory Capture

you know 0 people who could build healthcare.gov quickly, reliably, or cheaply. it's not like it's something you can hack together with a few mountain dews and pizza over a weekend or even two. the sheer complexity of the project is mind-boggling, considering they have to interface with 50 different healthcare marketplaces in addition to the ones that they run. that plus all the legal hoops and you're talking a multi-year project for millions of dollars. as it is, the site is over 500 MILLION lines of code. for some perspective, windows 7 is 50 million.

anyone who says, "oh yeah i could have built healthcare.gov in X number of days for Y number of dollars, easy" is either lying to you or a complete moron.

Re: Re: Regulatory Capture

Response to: That Anonymous Coward on Oct 10th, 2013 @ 10:37pm

No that is exactly what should scare the hell out of you. All that data is being protected by the same incompetent people because the talented in this field don't want government pay or are unwilling to be involved with that. For those of you who know anything about literal Web app security 101/shit I learned in my first semester of college in IT go to health care.gov and search ';' and wait for the autocomplete results if you haven't already. Literally, I want to kill myself from the amount of WTF going on here. Yet, doing so gave me the biggest laugh I've had in a long, long while

Re: Re: JavaScript, the Americans With Disabilities Act, and the Third Amendment.

Not to mention Javascript isn't installed... It's an interpreted language that is run in the browser similar to... Html lol. What a joke. I'm not even going to get into his "technical" points on security here because the entire thing was to baffling once he started giving out those rofllinks

Healthcare.gov snafu

It can be said that if you want to completely tie your hands behind you and learn to type with your nose; let committee and govnment contractors write up three years of "white papers" and "needs assessments".

Maybe, MAYBE in 10 years you'll get a system that was designed 6 years and ten OS's ago and NO ONE will even think to update the tech, data support or software si that your state of the art system will be defunct before you even get to ise it; and due to conflicts from the get go, wont work anywsy.

Since when did Big Brother adopt MicroSoft's tactic of letting the tech savvy "Joe publics" beta test a system AFTER paying for it??

Untuit and other smart companies in the late 90's and early oughtied; learned to use us beta testers to try out and debug the system BEFORE letting it go live.

Some how all that seems but a dream.I will continue to ask 3 questions.1. How many states with democratic leadership; both Federal and statewide, have had no real issues with rollout, ergo 2. How many Republican overrun states are having difficulties?Lastly but most importantly...3. How could anyone in their right mind think that in the face of multiple MILLIONS of employees being bamboozled by their company based healthcare enrollment period, think that opening what could be less difficult, better coverage and easier to pay for exchanges were EVER GOING TO WORK, until all those already insured captive employee health insurance policies had been locked in.

I can almost Guarantee you that healthcare. Gov won't work until every last employee and Medicare enrolled senior has been Licked into their 2014 elected healthcare coverage.

No companies are giing to take the chance that their convoluted horrible policies ate going to be chucked by the wayside to have their captive employees not pay a large share of big business's corporate health plans.Same with Medicare. We won't see improvement on the AFC until big business has cut their losses by keeping the website down until employees can't get out of employer based healthcare.

In Florida a bill was passed in the republican held Fl legislature and Mr. Scott that lets all health insurance companies have FREE REIGN to charge anything they want to for two whole years starting this enrollment period. And all they have to use to justify the rate hike is to say "That it's the fault of " Obama care"; when in reality it's Gov. Scott amd his big biz cronies wrecking havoc to all of their citizens. The insurance commissioners hands are supposedly tied because Gov Scott signed that bill into the laws of FL for the next 2 years!Disgusting.TheHerbalCupboard

Re: Re: It's all perspective

Who has the guns, the private corporations or the government? Also, corporations are fictitious legal entities created by... wait for it... the government! So tell me, what is the real "corrupter" here: the corporations whose taxable revenues are largely used to fund the government and who take advantage of the "legal power" given to them, or the government who forces businesses and citizens to fund them using coercion?